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Sept. 13, 2011 -- More than two-fifths of adults may not tell their doctor that they have been feeling depressed, according to a survey.

The reasons vary, but many are concerned that their doctor would prescribe an antidepressant that they don't want to take. Other reasons include the belief that it is not the job of a primary care doctor to address emotional issues and concerns about keeping medical records confidential.

Regardless of why people don't want to talk about depression, the result is the same: Depression falls under the radar.

The new findings are published in the Annals of Family Medicine.

"It is clear that left to their own devices, many patients will not report important symptoms spontaneously," conclude the study researchers, who were led by Robert A. Bell, PhD, of the University of California at Davis. "This finding underscores the need to develop and test office-based interventions that address these patient concerns and motivate disclosure of depression."

Bell and colleagues surveyed 1,054 California residents by telephone. The participants were asked why they wouldn't tell their primary care doctor about any symptoms of depression and about their beliefs about depression.

Of those surveyed, 43% gave at least one reason for not discussing depression with their primary care doctor.

Past history of depression played an important role in how people answered the survey questions. For example, people with a history of depression were more concerned about privacy and losing emotional control.

People with no history of depression were more likely to think that depression falls outside of the scope of a primary care doctor. They were also more worried about being referred to a psychiatrist or being treated with medication, the study showed.

Symptoms of Depression

Getting people to discuss symptoms of depression with their doctor is the most direct way to recognize and treat depression, the researchers suggest.

The news in the survey wasn't all negative. Seven of eight people said that primary care doctors were capable of identifying and treating depression. And few people said they were scared to broach the topic of depression for fear of embarrassment or losing face.

"We have come a long way, but this study reflects that fact that we need to continue to work at educating patients and primary care doctors," says Alan Manevitz, MD, a psychiatrist at New York' City's Lenox Hill Hospital.

Today, the majority of prescriptions for antidepressants are written by non-psychiatrists, he says.

"Depression is ubiquitous," Manevitz says. "Fourteen million Americans are depressed." Of these, just half will get treatment, and only half of these will receive adequate treatment.

The availability of newer antidepressant drugs with fewer side effects and direct-to-consumer advertising campaigns have helped get more people to talk about and seek treatment for their depression.

But "there may be some backlash against medication and side effects because the commercials end up making people fearful," he says.

One thing is clear: "If you are not disclosing your emotional symptoms, you are actually handicapping the primary care physician from being able to properly diagnose and treat you," Manevitz says.